Clinical Decision-Making Framework
Clinical Decision-Making Framework
Narrative to accompany Interactive Clinical Decision-Making Framework OER CCBY license
Patricia Abbott Ph.D., MSN, RN, FNP-BC
Background
Diagnostic errors account for unacceptable levels of harm in the United States. The consensus study report from the Committee on Diagnostic Error in Health Care from 2015 stated that diagnostic errors would continue without dedicated focus to improve health care diagnosis. (National Academies of Sciences, Engineering, and Medicine. (2015).
Responding to the call to action
As an educator of Nurse Practitioner (NP) students, teaching clinical decision-making (CDM) presents a challenge as it is a multifaceted process dependent on critical thinking. A literature search did not yield a stepwise approach to guide health care students through the CDM process. This framework, based on different diagnoses, allows students to interact with the framework as they add evidence-based data to distinguish one condition from another using the history of present illness and directed exams. This helps the student learn to narrow the differential and guides them to determine what diagnostics are indicated. This process leads the student to an evidence-based diagnosis.
How to use the interactive CDM framework
The CDM framework can be used in various ways and has been modified for other uses in educating students. An effective approach is to introduce the framework after a brief presentation on CDM, including critical thinking and the concept of differential diagnosis. Included in the presentation is a case where no differential diagnosis was considered. Consequently, the patient died at home twelve hours after leaving the primary care provider's office. Following the case presentation, which always impacts students, the CDM framework is introduced as a large visual image for students to see. They offer input on what was not considered as possible diagnoses that led to the deadly outcome. Then, students continue to work as a large group on other chief complaints. The students are then divided into smaller groups to use the framework on provided cases. At some point, students have an assignment to complete the framework individually to assess each student's competency in the CDM process. Throughout the presentation and group work, using evidenced-based resources is emphasized. In this way, they learn the CDM process while learning about the disease processes they are ruling in and or ruling out.
Student feedback
This Interactive Clinical Decision-Making Framework has been a valuable resource for students who have given consistent positive feedback. A verbatim comment: "The Clinical Decision-Making Framework has been indispensable in guiding clinical decision-making and diagnostic reasoning. As novice FNP students –learning new ways of thinking doesn't always come easy and the comprehensive Framework ensured critical elements of clinical decision making were considered."
Reference
National Academies of Sciences, Engineering, and Medicine. (2015). Improving diagnosis in health care. https://doi.org/10.17226/